NPI | 1699498477 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102208772) |
Additional Taxonomies | 171000000X Military Health Care Provider |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-09-26 |
Last Update Date | 2024-07-15 |